Alyssa's Fight

My daughter is a high-level competitive athlete in an extremely difficult and demanding sport.  She trains a minimum of 22.5 hours a week and is freakishly strong for her size.  She's had to be willing to push her body through aches and pains, overcome fear and become a master of time management, while also missing out on many "normal" teenager things.

I cringe when some assume (and even say to me) that she's good at what she does simply because of the amount of time she spends in the gym.  *Full body cringe*  Yes, the amount of time she trains is absolutely key to being successful, but let me emphatically state this: Alyssa has excelled in gymnastics because she has the physical, emotional and mental aptitude to do so.  She has achieved a level that many, many others do not.

According to USA Gymnastics, in 2008, 69,797 female gymnasts were registered in the Junior Olympic program nationwide.  Of that number, 21,766 of those girls were level 4--a beginning level of competitive gymnastics.  By level 7, the number dropped to 7,623 and at level 9--the level where Alyssa spent her last two competitive seasons--the number plummeted to 3,248.  Only about half of that number achieved level 10 and a mere 79 reached the insanely difficult elite level.  All in all, only 7% of gymnasts are level 9 and higher.  Of the 3,248 level 9 gymnasts, about 900--450 at Westerns and 450 at Easterns--qualify to compete at the national level.

Alyssa has done that twice.

Lots of people--friends and family, even--make statements or ask questions that reveal their obvious disapproval of the time and money we invest in the sport. Many more seem disinterested or don't appreciate the talent Alyssa has or the remarkable drive she displays toward reaching her goals.  Very few understand the devastation that came when an injury threatened to rewrite the future Alyssa has dreamed for herself.

We don't know how her gymnastics story will end, but we do know she's a fighter.  In fact, I can't even listen to Rachel Platten's "Fight Song" without tearing up.  It became Alyssa's favorite song last summer after she'd pushed through a terribly disappointing Westerns, an open fracture on her big toe and a ganglion cyst on her ankle.  She had no idea the worst was yet to come, but when she'd dance and sing her heart out to the lyrics, I knew she meant it:

"My power's turned on

Starting right now I'll be strong

I'll play my fight song

And I don't really care if nobody else believes, 

'cause I still got a lot of fight left in me."

"My elbow was really hurting today," Alyssa told me when I picked her up from gym last October. Her quivering voice and teary eyes revealed her panic.  She's the antithesis of dramatic and though I told her to try not to worry, I think she knew right then and there that something was seriously wrong.

Every so often over the last few years, Alyssa has experienced what she would describe as a "stinger" in her elbow.  When it would bother her, I'd make an appointment with the chiropractor and it would instantly feel better.  I thought it was nothing more than a pinched nerve.  This time was different.

"I did not like the feel of her elbow today.  It is very angry," the chiropractor said to me.

Over the next few weeks, Lys would either rest from practice or practice without using her arms. The elbow would always feel better with rest and then she'd return to training.  The pain kept coming back, however, and soon the joint was catching and locking and she'd lost range of motion.  When we went to see the chiropractor again at the beginning of November, he suggested seeing an orthopedic doctor.  Up until that moment, I must have been in denial because I hadn't been too worried. All at once, the light bulb went on and my gut told me that this was more than a usual ache or pain.

I googled "elbow injury in gymnast" and after reading this article, I knew what we were dealing with. I called for an appointment with a certain sports medicine doctor at Children's in Seattle that had seen many of Alyssa's teammates and came highly recommended.  The problem was, we couldn't get in to see her for several more weeks!  I knew an MRI was going to be ordered and didn't want to wait until then just to get that done, so I started calling around for a doctor that could see her in the meantime. Oh boy did I get the run-around.  Every doctor's office sent me to another.  Five tries later, I finally found one that would agree to see a pediatric elbow.  I secured an appointment for the very next day and an MRI the day after that.

When we went for the MRI, I also requested a copy of the images in hopes that my brother-in-law, Jay, who is a radiologist (and lives four states away), would read them for me. We were exceptionally antsy now and I didn't want to have to wait the whole weekend to hear the official results of what I already knew.

Jay was a gem and agreed to read the images over Facetime.  He said this image confirmed the Osteochondritis Dissecans or OCD:

Here's how Dr. Hill Hastings described the injury in the article he wrote for USA Gymnastics:

WHAT IS OSTEOCHONDROSIS DESSICANS

(OCD)?

OCD affects the cartilage surface of the capitellum and the

bone support just underneath. Usually there is collapse of

the underlying bony support that then leads to a crack or

separation in the cartilage surface.

Over time the section of the cartilage

surface involved may become detached, float around in the

joint, and at times get caught between joint surfaces. In late

cases it can damage the opposing joint surface of the radial

head. OCD is common in adolescent baseball players and

also in female gymnasts.

From our research, we understood that three months of rest was the first course of action.  With the first competition just two months away, it was clear that this injury would impact at least the beginning of the season. We tried to remain positive and not allow ourselves to dwell on the fact that many gymnasts don't return from this injury.

Unfortunately, time alone would not heal this wound.

When we finally saw Dr. Burton at Seattle Children's at the end of November, she confirmed the diagnosis but then said she wanted to consult with a colleague on the best steps to take next.  She stated that they had been seeing more and more of these injuries in gymnasts, but that the exact causes aren't clear.  It would be a couple more weeks of waiting before it would finally be suggested that an MRI with contrast should be done to provide a more clear view of the stability of the lesion in Alyssa's elbow.

Scheduling appointments, waiting for doctors to consult with one another, waiting for MRI results, scheduling more appointments...it was a long and annoying process.  It was just three days before Christmas when we finally got the second MRI done.

The decor at Children's is so stinkin' cute.  The hospital pants aren't.  But then again, Lys looks cute in everything.  And she's always unbelievably calm.  And brave.

A doctor injected a dye into her arm while another used ultrasound to make sure it was all going in the right location.  Then we were sent back to wait for the MRI.

After several more weeks--the holidays really prolonged the process--Dr. Burton felt that the results, coupled with Alyssa's continuing symptoms, warranted a visit with an orthopedic surgeon.  The lesion, Dr. Burton felt, was unstable.  Knowing the opinions of her colleagues at Children's, she feared they would simply tell Alyssa she could no longer do gymnastics.  So instead, she sent us to one she knew would try to help her return to sport, Dr. Gee at the University of Washington.

It was mid January when we finally got to see him.  He told Alyssa that the choice was hers, but if she wanted to continue doing gymnastics, surgery was likely needed because it clearly had not improved in the now two months that she'd rested it.  It was a heavy decision at a heavy time in life--we would learn the very next day that Jon's mom would die.

She was not excited about having surgery, but Alyssa wanted to be given a chance to return to the sport she loves.  She what I mean?  She's a fighter.

Her pre-op was scheduled for February 2nd, the very next day after returning from Karen's funeral.

Two days later, on February 4th, we arrived very early at the University of Washington surgery pavilion.  She was by far the youngest patient on the schedule that day.  My mom heart was tense.

We stayed with her while they prepped her for the operating room.  

Dr. Gee selected a small, disposable purple pen from a cup and signed his initials on her left elbow. He asked us to verify that that was the arm being operated on and then he promised to take care of our baby girl.  Oh boy did I pray as I watched them wheel her away down the hall.

About an hour later, we received a call from the operating room nurse.  She informed us that Alyssa was doing great, that Dr. Gee had removed the damaged cartilage and was proceeding with the microfracture portion of the surgery.  Screens in the waiting room kept families informed of their loved ones progress.  We kept watching it, waiting for news that she had been moved to recovery.  I think we checked it every two minutes.

Dr. Gee would later give us photos of the surgery.  This first page shows the removal of the cartilage:

On this page, the bone is seen.  The sixth photo shows the tool the surgeon used to drill holes into Alyssa's bone.  Evidently it was a tool usually used for wrists, but because of her tiny stature, was used for an elbow in this case.  The bottom two photos show the holes in the bone after they were drilled.

And finally, the pictures of blood and bone marrow flowing from the holes.  According to Dr. Gee, these images were exciting enough to elicit high-fives in the operating room.  After all, that blood and marrow were necessary to form a clot and serve as a patch in the place where the damaged cartilage had been.

Dr. Gee and another surgeon who assisted in the operation came to talk to us. It was clear that he felt very good about how it all went.  He said Lys was starting to wake up and would be moved to recovery shortly.  The patient information screen finally revealed that Alyssa was in recovery, but it would be over another hour before we were taken to see her! 

When we finally got to see her, she managed a smiled for us, but struggled to stay awake.

We would have to spend quite a bit more time in recovery as the anesthesia was making her quite sick.  Poor baby.

She slept all the way home and pretty much an entire day after that.  Her pain was well controlled, though, and she was in fact totally off medication within two days.

She would have to wear the brace for six weeks, but after 48 hours we could remove the badges.  So bulky!

We were surprised to see all of Dr. Gee's artwork.

She was even well enough to accompany us to the grocery store.  You can hardly tell she's got a bionic arm under that sweatshirt:

Her friends were so good to her.  Between the funeral and Alyssa's surgery, our table was filled to overflowing with gifts, cards and flowers.  It's so good to feel loved.

How will this story end?  Will Alyssa return to competition?  I've seen so many others give in when injury, fear or laziness crept in.  "Why do you keep going, Alyssa?  Why do you want to do through all of this?" I asked her one day.

"I have a goal," was her simple and straightforward reply.

We don't yet know if that goal will be reached, but we do know Alyssa has a lot of grit. Her determination and courage are qualities that will serve her well in life, no matter how her gymnastics story ends.

She's a fighter.

She inspires me.